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Bolia IK, Covell DJ, Tan EW. Comparative Studies of Bone Graft and Orthobiologics for Foot Ankle Arthrodesis: A Critical Review. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00004. [PMID: 38704857 PMCID: PMC11068146 DOI: 10.5435/jaaosglobal-d-23-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/03/2024] [Indexed: 05/07/2024]
Abstract
Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.
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Affiliation(s)
- Ioanna K Bolia
- From the Department of Orthopeadic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Dr. Bolia, and Dr. Tan), and the Danville Orthopeadics and Sports Medicine, Danville, KY (Dr. Covell)
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Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study. J Orthop Surg Res 2022; 17:526. [PMID: 36476296 PMCID: PMC9730565 DOI: 10.1186/s13018-022-03413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This retrospective study aimed to introduce a novel method for simultaneous Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion and to evaluate the feasibility of this method. METHODS We retrospectively analysed the clinical and imaging data of 11 patients with calcaneus malunion treated using Y-shape osteotomy and subtalar arthrodesis who were admitted to our hospital from June 2018 to October 2020. The patients included 9 males and 2 females aged from 24 to 69 years old, with an average age of 42.18 years. The clinical and radiological results were assessed with the Visual Analogue Scale (VAS) pain score and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. In addition, functional recovery and general quality of life were evaluated using the 12-Item Short-Form Survey (SF-12). RESULTS All radiological parameters were significantly improved at the last follow-up, with increases of 14.37°, 9.18°, and 4.51 mm in the Böhler's angle, calcaneal pitch angle, and talocalcaneal height, respectively, and decreases of 6.39 mm and 6.18° in the calcaneal width and Hindfoot alignment angle (p < 0.05). The mean AOFAS and VAS scores at the last follow-up improved compared with those preoperatively, from 34.18 ± 9.53 to 84.18 ± 11.59 and from 6.90 ± 1.22 to 1.90 ± 1.13, respectively (p < 0.05). The SF-12 physical and mental health scores were 49.65 ± 6.84 and 52.68 ± 7.88, respectively. Furthermore, the early postoperative complications included skin necrosis in one and sural neuralgia in one patient, and the late postoperative complication included ankle pain in one patient. No other complications, such as implant discomforts, malunion, nonunion and re-fracture, were presented. CONCLUSION These results indicate that Y-shape osteotomy combined with subtalar arthrodesis is an effective new method for the treatment of calcaneal malunion. Advantages include improvement of the anatomic shape of the calcaneus and union rates for subtalar arthrodesis.
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Konovalchuk N, Sorokin E, Fomichev V, Chugaev D, Kochish A, Pashkova E, Mikhaylov K. Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option? Foot Ankle Int 2022; 43:42-48. [PMID: 34384274 DOI: 10.1177/10711007211027298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning-even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. METHODS We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. RESULTS The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). CONCLUSION The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. LEVEL OF EVIDENCE Level III, retrospective cohort study, case series.
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Affiliation(s)
- Nikita Konovalchuk
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Evgenii Sorokin
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Viktor Fomichev
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Dmitrii Chugaev
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Alexander Kochish
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Ekaterina Pashkova
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
| | - Kirill Mikhaylov
- Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russian Federation
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Woo SH, Goh TS, Ahn TY, You JS, Bae SY, Chung HJ. Subtalar distraction arthrodesis for calcaneal malunion - comparison of structural freeze-dried versus autologous iliac bone graft. Injury 2021; 52:1048-1053. [PMID: 33423772 DOI: 10.1016/j.injury.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/04/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to analyze the outcomes of subtalar distraction arthrodesis (SDA) for calcaneal malunion using structural freeze-dried iliac allograft (FDIA) compared to using autologous iliac bone (AIB). METHODS We retrospectively evaluated 57 consecutive cases (51 patients) of calcaneal malunion between March 2006 and December 2017. All patients were followed for an average of 22.8 months. All cases were treated by SDA using structural FDIA (17 cases, group 1), or AIB (40 cases, group 2). The outcome measures included the American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores, visual analog scale (VAS) pain scores, and radiographic measurements. RESULTS The mean postoperative 3, 6, and 12 months of AOFAS scores and VAS pain score were significantly better in group 2 than those in group 1 (p < 0.05, for all). There were 3 cases (17.6%) of nonunion in the group 1, whereas the group 2 had 2 cases (5.0%), which did not shown significant difference between two groups (p = 0.492). Although the mean pre-, postoperative, and final follow-up radiologic parameters in both groups were similar, (p > 0.05, for all) the difference of talocalcaneal height, talocalcaneal angle, and talar declination angle from postoperative to final follow-up were significantly bigger in the group 1. (p < 0.05, for all). CONCLUSION Although union rate was not significantly different between the two groups, we obtained more favorable clinical and radiologic outcomes in the autologous iliac bone group. Using FDIA without any orthobiological agent for SDA, there were significant more loss of radiological parameters due to inferior incorporation and biomechanical properties. When considering the SDA for calcaneal malunion, routine use of FDIA without any orthobiological agents as an interpositional graft for SDA is not recommended.
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Affiliation(s)
- Seung Hun Woo
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Tae-Sik Goh
- Department of Orthopedic Surgery, Pusan National University Hospital, 179 Guduk-ro, Seo-gu, Busan 49242, Republic of Korea
| | - Tae-Young Ahn
- Department of Orthopedic Surgery, Pusan National University Hospital, 179 Guduk-ro, Seo-gu, Busan 49242, Republic of Korea
| | - Jun Sang You
- Department of Orthopedic Surgery, Inje University, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Su-Young Bae
- Department of Orthopedic Surgery, Inje University, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Hyung-Jin Chung
- Department of Orthopedic Surgery, Inje University, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
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Schnetzke M, El Barbari J, Schüler S, Swartman B, Keil H, Vetter S, Gruetzner PA, Franke J. Vascular impulse technology versus elevation for the reduction of swelling of lower extremity joint fractures: results of a prospective randomized controlled study. Bone Joint J 2021; 103-B:746-754. [PMID: 33789481 PMCID: PMC9950846 DOI: 10.1302/0301-620x.103b4.bjj-2020-1260.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation. METHODS A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular calcaneal fracture (n = 40). Patients were randomized to the two study groups in a 1:1 ratio. The effectiveness of VIT (intervention) compared with elevation (control) was analyzed separately for the whole study population and for the three subgroups. The primary endpoint was the time from admission until operability (in days). RESULTS The mean length of time until operability was 8.2 days (SD 3.0) in the intervention group and 10.2 days (SD 3.7) in the control group across all three fractures groups combined (p = 0.004). An analysis of the subgroups revealed that a significant reduction in the time to operability was achieved in two of the three: with 8.6 days (SD 2.2) versus 10.6 days (SD 3.6) in ankle fractures (p = 0.043), 9.8 days (SD 4.1) versus 12.5 days (SD 5.1) in pilon fractures (p = 0.205), and 7.0 days (SD 2.6) versus 8.4 days (SD 1.5) in calcaneal fractures (p = 0.043). A lower length of stay (p = 0.007), a reduction in pain (ppreop = 0.05; pdischarge < 0.001) and need for narcotics (ppreop = 0.064; ppostop = 0.072), an increased reduction in swelling (p < 0.001), and a lower revision rate (p = 0.044) could also be seen, and a trend towards fewer complications (p = 0.216) became apparent. CONCLUSION Compared with elevation, VIT results in a significant reduction in the time to achieve operability in complex joint fractures of the lower limb. Cite this article: Bone Joint J 2021;103-B(4):746-754.
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Affiliation(s)
- Marc Schnetzke
- German Joint Centre Heidelberg, ATOS Clinic Heidelberg, Heidelberg, Germany,Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany,Correspondence should be sent to Marc Schnetzke. E-mail:
| | - Jan El Barbari
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Benedict Swartman
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Holger Keil
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Sven Vetter
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Paul Alfred Gruetzner
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Jochen Franke
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
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Lipoteichoic Acid Accelerates Bone Healing by Enhancing Osteoblast Differentiation and Inhibiting Osteoclast Activation in a Mouse Model of Femoral Defects. Int J Mol Sci 2020; 21:ijms21155550. [PMID: 32756396 PMCID: PMC7432397 DOI: 10.3390/ijms21155550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 12/16/2022] Open
Abstract
Lipoteichoic acid (LTA) is a cell wall component of Gram-positive bacteria. Limited data suggest that LTA is beneficial for bone regeneration in vitro. Thus, we used a mouse model of femoral defects to explore the effects of LTA on bone healing in vivo. Micro-computed tomography analysis and double-fluorochrome labeling were utilized to examine whether LTA can accelerate dynamic bone formation in vivo. The effects of LTA on osteoblastogenesis and osteoclastogenesis were also studied in vitro. LTA treatment induced prompt bone bridge formation, rapid endochondral ossification, and accelerated healing of fractures in mice with femoral bone defects. In vitro, LTA directly enhanced indicators of osteogenic factor-induced MC3T3-E1 cell differentiation, including alkaline phosphatase activity, calcium deposition and osteopontin expression. LTA also inhibited osteoclast activation induced by receptor activator of nuclear factor-kappa B ligand. We identified six molecules that may be associated with LTA-accelerated bone healing: monocyte chemoattractant protein 1, chemokine (C-X-C motif) ligand 1, cystatin C, growth/differentiation factor 15, endostatin and neutrophil gelatinase-associated lipocalin. Finally, double-fluorochrome, dynamic-labeling data indicated that LTA significantly enhanced bone-formation rates in vivo. In conclusion, our findings suggest that LTA has promising bone-regeneration properties.
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